Patients may not perceive warning signs, such as excessive drowsiness, or they may report feeling alert immediately prior to the event. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Clonidine: (Moderate) Clonidine has CNS depressive effects and can potentiate the actions of other CNS depressants including benzodiazepines. Titrate to desired level of sedation. Specific maximum dosage information not available; the dose required is dependent on route of administration, indication, and clinical response.1 to 11 years: Safety and efficacy have not been established. ISMP Medication Safety Alert. Quetiapine decreases lorazepam clearance by about 20%. Draw into the dropper the amount prescribed for a single dose. Dose range: 0.025 to 0.1 mg/kg/dose. Nabilone: (Major) Nabilone should not be taken with benzodiazepines or other sedative/hypnotic agents because these substances can potentiate the central nervous system effects of nabilone. Butalbital; Acetaminophen: (Moderate) Additive CNS and/or respiratory depression may occur with concurrent use. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Attempt periodic tapering of the medication or provide documentation of medical necessity in accordance with OBRA guidelines. The federal Omnibus Budget Reconciliation Act (OBRA) regulates the use of sedative/hypnotics in long-term care facility (LTCF) residents. [7] Colsoul ML, Breuer A, Goderniaux N, et al. For the 1 mg/mL solution, 20 mL of the 2 mg/mL lorazepam preparation and 20 mL of 5% dextrose injection were added to a 250 mL evacuated bottle. Initiate with lower dosages and carefully monitor for sedation and other adverse effects. Zaleplon: (Major) Monitor for excessive sedation and somnolence during coadministration of zaleplon and benzodiazepines. Clemastine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Drug classes: Benzodiazepine anticonvulsants, Benzodiazepines, Miscellaneous antiemetics. There is evidence that tolerance develops to the sedative effects of benzodiazepines. Educate patients about the risks and symptoms of respiratory depression and sedation. Initially, 2 to 3 mg/day PO given in 2 to 3 divided doses. Educate patients about the risks and symptoms of excessive CNS depression and respiratory depression. Educate patients about the risks and symptoms of respiratory depression and sedation. When a higher dosage is needed, the evening dose should be increased before the daytime doses. Patients should not drive or operate heavy machinery until they know how the combination affects them. Alternatively, 0.05 mg/kg IM (Max: 4 mg) administered 2 hours prior to surgery or the procedure. Use carton to protect contents from light. Consume all the sprinkled contents within 2 hours. Pharmacokinetic interactions have been observed with the use of zolpidem. FOIA Concurrent use may result in additive CNS depression. If concurrent use is necessary, monitor for excessive sedation and somnolence. Formula Lorazepam 2 mg/mL Intramuscular Injection (Solution, 100 mL) FIN F 004 989 SUGGESTED PRESENTATION. If used together, a reduction in the dose of one or both drugs may be needed. Droperidol: (Major) Droperidol administration is associated with an established risk for QT prolongation and torsades de pointes. Basics Name LORazepam Pronunciation (lor A ze pam) Brand Names: US Ativan LORazepam Intensol Loreev XR Therapeutic Category Antianxiety Agent Antiemetic Antiseizure Agent, Benzodiazepine Benzodiazepine Hy. As with all benzodiazepines, the use of lorazepam may worsen hepatic encephalopathy; therefore, lorazepam should be used with caution in patients with severe hepatic insufficiency and/or encephalopathy. 4 mg/mL solution for injection . Lorazepam Gel Ativan Gel See labeling Expiration dates may vary depending on compounding pharmacy. 0.05 mg/kg PO as a single dose (Max: 4 mg) 45 to 90 minutes prior to procedure. 10 mg/day PO; maximum IM and IV dose highly variable depending upon indication. The 2 mg per mL oral concentrate is supplied as a clear colorless solution. An in vitro study demonstrated significant increases in lorazepam release from the extended-release capsule 2 hours post-dose with approximately 91%-95% and 37 -42% of drug release in the presence of 40% and 20% alcohol, respectively. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response. Homatropine; Hydrocodone: (Major) Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. The infant should be monitored regularly, and if sedation, nausea, reduced suckling, or other signs of toxicity are observed, either breast-feeding or the benzodiazepine should be discontinued. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. For a listing of Insulin Products and their. Concurrent use may result in additive CNS depression. Following a single 2-mg oral dose of 14 C-lorazepam to 8 healthy subjects, 884% of the administered dose was recovered in urine and 72% was recovered in feces. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. Eszopiclone: (Moderate) Concomitant administration of benzodiazepines with eszopiclone can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Max initial rate: 2 mg/hour. Follow with water. Use caution with this combination. Extension of expiration time for lorazepam injection at room temperature. Lorazepam may have abuse potential, especially in patients with a history of drug and/or alcohol abuse. The risk of dependence increases with higher doses and longer term use and is further increased in patients with a history of alcoholism or drug abuse or in patients with significant personality disorders. Cisapride: (Moderate) Cisapride may enhance the sedative effects of benzodiazepines. Elderly or debilitated patients may be more susceptible to the sedative effects of lorazepam. In mild cases, symptoms include drowsiness, mental confusion, paradoxical reactions, dysarthria and lethargy. (Major) Avoid concomitant use of medications formulated with alcohol and extended-release lorazepam capsules. All room temperature samples were not stable after 4 months. An additional 20 microliters were frozen at 80C for chemical stability testing. Avoid lorazepam extended-release capsules and utilize lorazepam immediate-release dosage forms that can be easily titrated. The https:// ensures that you are connecting to the Lorazepam 1 mg/mL in 5% dextrose injection or 0.9% sodium chloride injection was stable for 28 hours at room temperature in polypropylene syringes when the 2 mg/mL lorazepam preparation was used. Store at room temperature in a dry place. storage of the drug, lorazepam concentration did not substantially degrade over a 60-day period; lorazepam stored in an oven kept at 37 C experienced signicant degradation, suggesting that lorazepam's stability is heat-sensitive.4 Midazolam is thought to be stable at room temperature, but the heat stability and degrada- Acrivastine; Pseudoephedrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Use of PVC containers results in significant drug loss; PVC administration sets can also be expected to contribute to sorption losses.Dilute lorazepam injection with a compatible diluent such as 5% Dextrose Injection (preferred) or 0.9% Sodium Chloride Injection to a final concentration of 0.2 mg/mL. Vilazodone: (Moderate) Due to the CNS effects of vilazodone, caution should be used when vilazodone is given in combination with other centrally acting medications such as the benzodiazepines. Use caution with this combination. Do not store for future use. If methadone is initiated for pain in an opioid-naive patient taking a benzodiazepine, use an initial methadone dose of 2.5 mg PO every 12 hours. Throw away any part not used after 3 months. It appears glucuronide conjugation of lorazepam is increased in the presence of combined hormonal oral contraceptives; the clinical significance of this interaction is not determined. Stability at Room Temperature** FOR SPECIFIC INFORMATION, CONTACT MANUFACTURER After first use, store at a room temperature not to exceed 77F (25C). No evidence of carcinogenic potential emerged in rats during an 18-month study with lorazepam. Use caution with this combination. Increase gradually as needed and tolerated. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. The oral product prescribing labels recommend against the use of lorazepam in psychosis; however, benzodiazepines are commonly used in clinical practice for the acute management of psychosis and mania, as well as in the treatment of extrapyramidal symptoms associated with antipsychotics. If a mixed opiate agonist/antagonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the mixed opiate agonist/antagonist and titrate to clinical response. Monitor patients for decreased pressor effect if these agents are administered concomitantly. Nitroglycerin: (Minor) Nitroglycerin can cause hypotension. If a mixed opiate agonist/antagonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the mixed opiate agonist/antagonist and titrate to clinical response. We kept ativan in the regular pyxis. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. If tapentadol is initiated in a patient taking a benzodiazepine, a reduced initial dosage of tapentadol is recommended. Disclaimer. Lorazepam glucuronide, the inactive metabolite, may be highly dialyzable. Carbinoxamine; Phenylephrine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Monitor for an increase in lorazepam-related adverse reactions and consider reducing the dose of lorazepam if concomitant use of lorazepam and ombitasvir is necessary. The action of these drugs is mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). (Moderate) The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines. Reported elimination half-lives are 12 hours, 14 +/- 5 hours, and 20.2 +/- 7.2 hours for immediate-release oral formulations, the parenteral formulation, and the extended-release capsules, respectively. The effects of probenecid and valproate on lorazepam may be due to inhibition of glucuronidation. The manufacturer has no labeling that says excursions are permitted. Patients with a history of a seizure disorder should not be withdrawn abruptly from benzodiazepines due to the risk of precipitating seizures; status epilepticus has also been reported. Easy-to-use pens can be considerably different - only seven days in some cases, may lead to physical and psychological dependence. Cohen V, Jellinek SP, Teperikidis L, Berkovits E, Goldman WM. Storage: Refrigerate between 2 to 8C (36 to 46F). [4,5], Prefilled disposable single-use glass syringes with lorazepam 2 mg/mL were studied in instrumented boxes in an emergency medicine environment (variations in ambient temperature). [3], A study evaluated lorazepam 2 mg/mL injectable solutions in clear glass syringes under refrigeration (4-10 C), at ambient temperatures (15-30 C), and at oven-heated temperatures (38 C) for up to 210 days (see Table 2). Median Tmax was 14 hours (range 7 to 24 hours) following a single 3 mg dose of the extended-release capsules. While more study is needed, benzodiazepine-induced CNS sedation and other adverse effects might be increased in some individuals if DHEA is co-administered. Acetaminophen; Pamabrom; Pyrilamine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. The clinical significance of this interaction is not certain. Although the combination has been used safely, adverse reactions such as confusion, ataxia, somnolence, delirium, collapse, cardiac arrest, respiratory arrest, and death have occurred rarely in patients receiving clozapine concurrently or following benzodiazepine therapy. Infants of mothers who ingested benzodiazepines for several weeks or more preceding delivery have been reported to have withdrawal symptoms during the postnatal period. (Minor) Patients taking benzodiazepines for insomnia should not use caffeine-containing products prior to going to bed as these products may antagonize the sedative effects of the benzodiazepine. After 2 days, solutions of lorazepam stored in syringes at 5 3C were considered to be chemically unstable due to a loss of lorazepam concentration greater than 10%. Lorazepam dosage needs to be reduced by approximately 50% when co-administered with probenecid. Electric medication storage boxes are available and for long expeditions are a reasonable solution. Liquid (solution): Store in a refrigerator. In animal studies, melatonin has been shown to increase benzodiazepine binding to receptor sites. Yuhas EM, Lofton FT, Rosenberg HA et al. Other pharmacokinetic studies have found lorazepam to be stable for up to 210 days at room temperature. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate. Please review labeling for expiration date. Cyproheptadine: (Moderate) Coadministration can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. Lorazepam is an UGT substrate and dasabuvir is an UGT inhibitor. 2013;17(1):1-7. If such therapy is initiated or discontinued, monitor the clinical response to the benzodiazepine. Protect from light. Direct IV injection should be made with repeated aspiration to ensure that none of the drug is injected intra-arterially and that perivascular extravasation does not occur.Inject slowly over 1-5 minutes; do not exceed 2 mg/minute. Lorazepam Macure . Apraclonidine: (Minor) No specific drug interactions were identified with systemic agents and apraclonidine during clinical trials. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate.